Provider Demographics
NPI:1417376559
Name:SUNFLOWER PEDIATRIC EYE CARE & STRABISMUS LLC
Entity Type:Organization
Organization Name:SUNFLOWER PEDIATRIC EYE CARE & STRABISMUS LLC
Other - Org Name:SPECS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NATALIE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:KOEDERITZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:785-856-7732
Mailing Address - Street 1:346 MAINE ST
Mailing Address - Street 2:SUITE 400
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66044-1393
Mailing Address - Country:US
Mailing Address - Phone:785-856-7732
Mailing Address - Fax:785-260-6275
Practice Address - Street 1:346 MAINE ST
Practice Address - Street 2:SUITE 400
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66044-1393
Practice Address - Country:US
Practice Address - Phone:785-856-7732
Practice Address - Fax:785-260-6275
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-15
Last Update Date:2019-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0432373207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty